Deirdre Beckner Email & Phone Number

Lenoir City, Tn

Admissions and creating care plans for patients choosing Hospice/Palliative Care for a comfortable end of life transition with dignity. Assessing, evaluating, and implementing care plan goals on an ongoing basis.

Contacted and assessed targeted Behavioral Health and Substance Abuse population for case management needs of resources, education, and support through acute inpatient, residential, partial hospitalization, intensive outpatient program, and outpatient levels of care. Designed, implemented, evaluated, and updated care plans. Referred cases to Physician Review as needed for medical necessity and total quality management. Made referrals to network providers. Verified benefit and eligibility monthly or as needed. Communicated and assisted with Discharge Planners for assistance with discharge planning needs. Filled in as needed with the Utilization Management to verify medical necessity of acute inpatient certifications, residential, PHP and IOP using MCG and ASAM criteria’s. Monitored Care Plans, evaluated medical necessity, and communicated with providers for members with diagnoses on the Autistic Spectrum.

Made phone calls to members who were identified by their Health Plan as having one or more high-cost chronic conditions along with at least one of Anxiety, Depression, Substance Use Disorders, Pain, Smoking, or Obesity. Coached members to identify health and wellness goals and small steps to reach those goals within the 52-week program. Empowered the member to succeed with current medical treatment and alternative methods of positive coping skills and stress management therefore lowering Health Plan medical cost. Made referrals to Psychologist, Psychiatrist, and Nutrition Specialist to assist with empowerment.

Made pre-service, inpatient, and post-discharge calls to assess member needs (medication, education, follow-up appointments, home health, caregiver assistance, and transportation). Made referrals to Dieticians, Exercise Physiologist within the company. Met for case rounds with Regional Medical Director on complex care members. Contact ended due to COVID-19 and lack of Elective procedures.• Demonstrated abilities to work in multiple systems simultaneously.• Illustrated effective communication with members while promoting healthier lifestyles by telephonically assessing member needs, setting and implementing individualized goals and evaluating outcomes.• Demonstrated ability and efficiency to work independently from home remotely

Knoxville, Tennessee Area

Made post-discharge, observation, and emergency room phone calls to assess member needs (medication, follow-up appointments, home health, caregiver assistance, and transportation) after discharge. Made referrals to other departments as indicated and received referrals from other Humana Departments to assess member situations in providing education and referrals. Advocated for members to ensure members had a voice in treatment and outcomes.

Knoxville, Tennessee Area

Provided pre- and post-procedure assessments and care for patients receiving pain management injections and nerve blocks. Organized and maintained HIPAA, Safety, OSHA, and Federal compliance logs.

Charleston, West Virginia Area

Managed medical, mental health, and substance abuse cases. Made telephonically assessments of members post discharge for needs, researched high-utilization claims, assisted providers, and negotiated non-par contracts with facilities and providers. Provided skilled nursing pre-authorization / utilization management using MCG (Milliman) criteria.

Charleston, West Virginia Area

Handled behavioral health case management and inpatient utilization management. Assisted members in setting up or maintaining follow-up appointments with providers. Also had the opportunity to work as a Medical Policy Analyst updating and review all Medical and Durable Medical Equipment Policies for both Commercial and Centers for Medicare plans.